GW1--04202_Well Construction - GW1_20240717

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WELL CONSTRUCTION RECO (GW-1) For Internal Use Only:
1.Well Contr tor.Ieform on:
fP •14.WATER LONid
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•WellCon6tulerN®a FROM , TO DEaI]1FI701/
5.3
S /00 f.•
31yr, ft. .
ft. n
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NC
Well C�nnIe.otorr r 1 Ce�rtitScotlon�thrasher 15.OUTER CARING Orr nnl$n- eed wells OR LiNI Acidic)R(Rap Acidic)
/ �/A-/ C<Vh. 13 ry/11 -f-li FROM - TO DIAMETER TEOCIRfLq MATLIUAL
R ft le
Coe,gar Nerve
Vij C C 1..-� IC INNER CA91NG OR TUBING(geothermal dared-trap)
2.Well Construction Permit M: k 1 / FROM TO DIAMETER TIIIC]Ottas MATERIAL
Liii ail appilreble well ce...he,tlen remelts(l.e.WC.Comfy,Swear,Ferieece.etc.) -(.I n. ,C C> ft- 5 Wm'3.Well Use(cheek well nee): ft IT le. L n C i t v�
Wafer Supply Well: 17.8CREEN
FROM To IDI.METER SOT SIZE Tmclnrass MATERtAf.
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cultural UMurricipaWPublic ft. ft. ... In.
❑Geothermal(Heating/Cooling Supply) °Residential Water Supply(single) ft. it '— hr.'
Olndustrial/Cornme ciel °ResidentialWater Supply(shared) It GROUT —
Olrriptiop ❑We ls>160,000 OPD FROM ' TO MAi L ctkII 7IACZMIlfr METHOD t AMOili
Non-Water Supply Well: 0 ft Z�ti 7'
/�I )l tot
['Monitoring °Rtxrovery R it
'Weill,'"Well: • _�oY Lant� p(ern 1
R. It
❑Aquifer Recharge °Orou ndwater Remedialion
❑AgUlfler Stoenge end Recovery °Salinity Barrier 15.9AND/GRAYI:LPACIC(if■piellesble)
FROM TO _ MATERIAL EMFIACLatENCMETHOD
❑Aquifer Test OSto mwnter Drainage ft. It
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OBxperimentel Technology °Subsidence Control rt. it.•
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• OOeothermal(Closed Loop) °Tracer '10.DRILLING LOG(elter3 additional sheets if necessary)
OGeothennel(HealingfCooling Rehm) °Other(explain under 1f21 Remark) PROM To t DES(7lRIIQN(color,Imams,ieWnck tip,polo she, )
tt.
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4.Date Wells)Completed: (,,Z 8 -ty Well TON • --- La L.
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L�rA A Vr'M^ � �il'
Se.Well Location: JUL,I I lnr 1. •
•ea 5 carry-, LLC' rt.• UR ` `
• F.ci1hylbnner Name Facility IDlf(if epplloeble) ft.'`� • "'"`R I f c�i/�
1 // ,.
- T 1I h ...n. R v
Pbyvicd Address,Litt. r p r e` R (7 periK
�A),�.� , 11.REBIAR QIi
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Cotmt Portal identification No.(PIN) •
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5b.Latitude and longitude in degrees/mieah,/attend,or decimal degrees:
(if well field,one let/loon is sufficient)
22.Certification:
3G ' 3 ( 1 2-0aN kO gc�1317
NY 4011. lip.,-,irt f.trirA b.Is(are)the Hell(,): {OPermanenl or OTeroporary Sisnetare of Cerufieiflyell l�or,lraaar
///ill Dote
7.Is this a repair to an existing well: OYa or No. By signing tha fora,,I herebycerl thw the we l(:)wne(wire)contrn,cied in accordance wfal
IJA?CAC 02C:0100 er'1J,1IiCAC 07C.0700 Well Corinna-Noe Standards and that a cep)
if this le e repair,film(known well rerunrcetorr nt(oennwlen e:plotn the twine the of this record has en
repo/r ender HI remark secriee er en the bock of&e form. of beprerl deal to tiro weA e„+nr.
23.Site diagram or additional well details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the store You may use the back of this page to provide additional well construction info
construction,only 1 OW-I is needed. Indicate TOTAL NUMBBR of wells (add'See Over'in Rdrr:arls Box).You may also attach additional
drilled: pier if necessary.
3 Z a' 24.suphi TAL INSTRUCrIONs 9.Total well depth below land surface: •
For multlple well.,Ilse ell depths ifd/I]nenr(etee Ile-JB200'end7W� • (R') Submit this GW-1 within 30 days of well completion per the following:
f casing: 0 ,1L) 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Stalin water level below tap o
riveter level Is abase e,Np;,:eve"4-- `` /�J Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
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11.Borehole diameter: -10 ` O (In) 24b.For Iolectlon We °� ,ll,• C to DWR Und
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—� ergrotrnd Injection Castro:(I11C)
12.Welt construction method: 4 {-a r� Program,1636 MSC,Raleigh,NC 27699-1636
(i.e.ender,rotary.cable,direct A r - .
push,eta.) 14e.For Water Su I and Open-Loop Geolherioal Rehr,Wells:Copy to the
• county enva-enmente ealfh department ot we county FOR WATER SUPPLY WELLS ONLY: where irist
24d.For Water Wells roduicin over 100 000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) C�l Method of test j )' Penult rugrnm, a erg , 769 - 11
Ian. n:.r..r_-"--`___ ' IA,�rI L li t'